CGRN Hepatobiliary and Pancreatic Disorders 2 — Questions and Answers
Question 1: A patient with hepatitis C cirrhosis undergoes surveillance ultrasound revealing a 2 cm hepatic lesion with arterial enhancement and washout on MRI. What is the most likely diagnosis?
- Hepatic hemangioma
- Focal nodular hyperplasia
- Hepatocellular carcinoma (HCC) (Correct answer)
- Metastatic colorectal cancer
Correct answer: Hepatocellular carcinoma (HCC)
Arterial enhancement followed by portal venous washout on contrast imaging is the hallmark radiologic pattern of hepatocellular carcinoma in a cirrhotic liver.
Question 2: Which medication is first-line therapy for primary sclerosing cholangitis (PSC) to slow bile duct fibrosis?
- Ursodeoxycholic acid (UDCA)
- Cholestyramine
- Prednisolone
- No proven disease-modifying therapy currently exists (Correct answer)
Correct answer: No proven disease-modifying therapy currently exists
Unlike PBC, PSC has no proven disease-modifying medical therapy; management focuses on symptom control, surveillance, and liver transplant evaluation for end-stage disease.
Question 3: A cirrhotic patient develops sudden onset fever, abdominal pain, and ascitic fluid with PMN count >250 cells/mm³. What is the diagnosis?
- Secondary bacterial peritonitis
- Spontaneous bacterial peritonitis (SBP) (Correct answer)
- Hepatic encephalopathy
- Portal hypertensive gastropathy
Correct answer: Spontaneous bacterial peritonitis (SBP)
Spontaneous bacterial peritonitis is defined by an ascitic fluid PMN count ≥250 cells/mm³ without an evident surgically treatable source, and is a life-threatening complication of cirrhosis.
Question 4: Which scoring system is used to assess short-term mortality risk in acute variceal bleeding in cirrhotic patients?
- Glasgow-Blatchford Score
- AIMS65 Score
- Child-Pugh Score
- MELD-Na Score (Correct answer)
Correct answer: MELD-Na Score
The MELD-Na (Model for End-Stage Liver Disease-Sodium) score is the primary tool used to predict 90-day mortality in cirrhotic patients and prioritizes liver transplant allocation.
Question 5: A patient with chronic pancreatitis presents with foul-smelling, oily stools and significant weight loss. What is the underlying mechanism?
- Bile acid malabsorption
- Exocrine pancreatic insufficiency causing fat malabsorption (Correct answer)
- Small intestinal bacterial overgrowth
- Celiac disease triggered by chronic inflammation
Correct answer: Exocrine pancreatic insufficiency causing fat malabsorption
Chronic pancreatitis destroys acinar cells, reducing pancreatic lipase secretion and causing fat malabsorption, which manifests as steatorrhea.
Question 6: Which type of biliary stricture is most likely to develop after laparoscopic cholecystectomy?
- Bismuth type I — low common bile duct stricture (Correct answer)
- Hilum stricture with hepatic duct involvement
- Intrahepatic biliary stricture
- Cystic duct remnant stricture
Correct answer: Bismuth type I — low common bile duct stricture
Post-cholecystectomy bile duct injury most commonly occurs at the distal common bile duct, classified as Bismuth type I, due to clip misplacement or thermal injury during surgery.
Question 7: A 45-year-old with acute liver failure has an INR of 3.8 and grade III encephalopathy. Which criterion must be met to qualify under King's College Criteria for emergency liver transplant listing?
- Serum bilirubin > 10 mg/dL
- ALT > 5000 IU/L
- PT > 100 seconds (INR > 6.5) OR any 3 of: age, etiology, bilirubin, time to encephalopathy (Correct answer)
- Creatinine > 2.0 and sodium < 130
Correct answer: PT > 100 seconds (INR > 6.5) OR any 3 of: age, etiology, bilirubin, time to encephalopathy
King's College Criteria for non-acetaminophen acute liver failure require PT > 100 seconds (INR > 6.5) or any combination of three adverse factors including unfavorable etiology, age extremes, jaundice-to-encephalopathy interval, and bilirubin > 17.5.
CGRN Hepatobiliary and Pancreatic Disorders 2
A patient with hepatitis C cirrhosis undergoes surveillance ultrasound revealing a 2 cm hepatic lesion with arterial enhancement and washout on MRI.
What is the most likely diagnosis?